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Cited by 51Transplantation: Methods and OutcomesRenal Transplantation Outcomes and TreatmentsOrgan and Tissue Transplantation Research

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The impact of first untreated subclinical minimal acute rejection on risk for chronic lung allograft dysfunction or death after lung transplantation

Open access
Levy, Liran, Huszti, Ella, Tikkanen, Jussi, Ghany, Rasheed, Klement, William, Ahmed, Musawir, Husain, Shahid, Fiset, Pierre O., Hwang, David, Keshavjee, Shaf, Singer, Lianne G., Juvet, Stephen, Martinu, Tereza·2020·American Journal of Transplantation
DOI 10.1111/ajt.15561
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Abstract

Acute cellular rejection (ACR) is a significant risk factor for chronic lung allograft dysfunction (CLAD). Although clinically manifest and higher grade (≥A2) ACR is generally treated with augmented immunosuppression, management of minimal (grade A1) ACR remains controversial. In our program, patients with subclinical and spirometrically stable A1 rejection (StA1R) are routinely not treated with augmented immunosuppression. We hypothesized that an untreated first StA1R does not increase the risk of CLAD or death compared to episodes of spirometrically stable no ACR (StNAR). The cohort was drawn from all consecutive adult, first, bilateral lung transplantations performed between 1999 and 2017. Biopsies obtained in the first-year posttransplant were paired with (forced expiratory volume in 1 second FEV 1 ). The first occurrence of StA1R was compared to a time-matched StNAR. The risk of CLAD or death was assessed using univariable and multivariable Cox proportional hazards models. The analyses demonstrated no significant difference in risk of CLAD or death in patients with a first StA1R compared to StNAR. This largest study to date shows that, in clinically stable patients, an untreated first A1 ACR in the first-year posttransplant is not significantly associated with an increased risk for CLAD or death. Watchful-waiting approach may be an acceptable tactic for stable A1 episodes in lung transplant recipients.

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Research works printed but not linked: 31

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Metadata

Authors
Levy, L., Huszti, E., Tikkanen, J., Ghany, R., Klement, W., Ahmed, M., Husain, S., Fiset, P. O., Hwang, D., Keshavjee, S., Singer, L. G., Juvet, S., & Martinu, T.
Affiliations
University Health Network (CA)
Corresponding author
Martinu, Tereza
ORCID
Venue
American Journal of Transplantation
Publisher
Elsevier BV
Published
2020-01
Volume
20
Issue
1
Pages
241-249
ISSN
1600-6135 (ISSN-L)
DOI
10.1111/ajt.15561
OpenAlex
W2968507076
Cited by
51
References
1
Citations by year
2026: 3 · 2025: 6 · 2024: 14 · 2023: 9 · 2022: 6 · 2021: 6 · 2020: 6
FWCI
4.58
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Transplantation (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Canadian Institutes of Health Research
  • Cystic Fibrosis Canada
Topics
  • Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
  • Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
  • Health Sciences › Medicine › Transplantation › Organ and Tissue Transplantation Research
Keywords
acute cellular rejection, subclinical acute rejection, chronic lung allograft dysfunction, lung transplantation, expectant management, post-transplant mortality, FEV1
MeSH terms
Aged, Female, Follow-Up Studies, Graft Rejection, Graft Survival, Humans, Lung Diseases, Male, Middle Aged, Postoperative Complications, Prognosis, Retrospective Studies, Risk Factors, Survival Rate, Lung Transplantation, Allografts

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